Provider Demographics
NPI:1598262982
Name:BISSON, MARK LUCIEN SR
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:LUCIEN
Last Name:BISSON
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6462 OTIS RD
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34287-2258
Mailing Address - Country:US
Mailing Address - Phone:941-413-6891
Mailing Address - Fax:
Practice Address - Street 1:6462 OTIS RD
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34287-2258
Practice Address - Country:US
Practice Address - Phone:941-413-6891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-11
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)